Kowalski, PaulFOR INTERNAL USE ONLY
Received by: Joseph P. Paoloni l !
Grace Robinson F1
C,0 Y-1��, r"( (_0 0 D)Q5
2010-01-15 JCM
Town of Wappinger
Application for Hawkers
& Peddler's Lisense
does hereby apply to the Town of Wappinger Town Clerk for a
license for Hawking and Peddling pursuant to Town of Wappinger Local Law No. 10 of 1992,
regulating Hawkers and Peddlers in the Town of Wappinger, and in connection with such
application, does state the following: IMEVERE
1) Applicant:
NAME: AGE:
CURRENT ADDRESS:
(St (Street) (City) t (state) ������re:w°
IP)
PHONE#
PERMANENT ADDRESS (if different);
(St #) (Street) (City) (State) (ZIP)
If Applicant is an Agent or Employer: Tape a 2"X 2"
Applicant's Employer ower Home Reffodelnng Group color photo (less
Address of Employer 60 Commerce Dr Trumbull CT 06611
than 60, days Old)
(St- #) (Street) (City) (State) (ZIP)
Proof of Employment _Agach!Q-4-pplication)
2) Nature of Business:
r- ree wi Sdj-tiq Coo f J dors
N Motor Vehicle (circle one): car truck) van
L On Foot &/or with vehicle drawn by hand or anima
Vehicle Info: Vehicle Make Vehicle Model
License Plate#
State of Registration
Operator's License Number ....... ....
LJ Weights & Measures Certificate Certificate 0
F1 Dutchess County Health Dept Permit Permit #
2010-01-15 JCM
3) Veteran Status
❑ Veteran Applicant - Exempt from license fee (attach certificate from Dutchess County)
Names of all other municipalities in which the applicant has been a vendor in the preceding 6
months:
4) Compliance
That the applicant, if the License requested hereby is granted, consents and agrees to conduct the
aforesaid business or activity pursuant to all of the terms and regulations of the Local Law above
specified, and all other rules, regulations and Laws governing ones activities in the Town of
Wappinger as a Peddler or Hawker.
Dated:i /f� , 20 s
Wappingers Falls, NX,
Sworn to before me this
day of aL _, 20JZ-
otary Public
Signature of Applicant
Nota t 1sc �5tatpr.Er
Notary Pub11c - State at Ne
M Uelfmo. it, S �qf 776 w York
Y cornm{sstanln 5 k CaUnty
Ale xprres ovt 18, 2425
Application must be accompanied by a fee of Two Hundred Dollars ($200.00), payable to
the Town of Wappinger. This is a non-refundable fee.
Applicants possessing a valid Dutchess County Veterans Vendors License are exempt from
the $200.00 fee, provided that a copy of said license is attached to the application.
New York State Department of Taxation and f=inance
Certificate of Authority
Identltication number `
23-3030708
(Use this number on afi returns and correspondence)
POWER HOME REMODELING GROUP, LLC
.25031 SEAPORT DR STE B110
CHESTER PA 19013-2249
1 5I
Dept of Tax
and Finance
is authorized to collect sales and use taxes under Articles 28 and 29 of the New York State Tax Law.
Nontransferable
This certificate must be prominently displayed at your place of business.
Fraudulent or other improper use of this certificate %111 ceruse It to be revoKed,
the oeirtifloate may not be photocopied or reproduced.
phamuraphe - copyright or NYS Empire State Development
4020109100098 ID138»0880035 P0000235-01 DTF-17-A(8l10)